Ever since Christina Farr of CNBC broke the news of Amazon expressing an interest of getting into the Billion Dollar Pharmacy market, I have been having multiple conversations with many people inside and outside of pharmacy on how this will change "everything."

Personally, I haven't seen this much attention in awhile about pharmacy since PillPack made strip-packaging of medications mainstream three-years ago, and am quite eager to see if this is really going to change the current paradigm of pharmacy services.

Nonetheless, having Amazon as a disruptive player in the pharmacy sphere is worth having some thoughts about, for those inside the pharmacy space and outside have some very different takes on the matter. For one, most pharmacists really don't see Amazon getting into the space for a few more years, and not much changing if they do. Rather, it's just 'one more mail order pharmacy.' But those outside of pharmacy, see a drastic change in the landscape. I think this difference in views comes down to several items. If you are interested in those, please read on, otherwise if you want to see how I think Amazon could change things skip ahead.

The primary issue is what is pharmacy and drug dispensing in the 21st Century United States. It definitely isn't the apothecary from "A Wonderful Life," or the cozy independent store in the center of town with a telephone operator in the back and a soda shop up front. Rather, it is the hectic fast paced drive-through endeavor with a 15-minute wait feature that most patients after visiting their doctor see. Pharmacy has drastically changed, and with the patient view of most pharmacists just 'Count-Lick-and Pour' medications for patients it's not hard then to think of how to just automate the process. Which, to be honest, is a thing right now. Many large pharmacy operations now use automation technology (whether a community pharmacy or a hospital) to aid in the process of dispensing medications. It's what makes a large scale mail-order pharmacy operation possible. And it's also what makes some start-ups consider making corner pharmacies (or Redbox Pharmacy as I like to call them) a thing to the place outside of Emergency rooms and clinics. So yes, for the general public, the view of just having Amazon mass dispense medications is a no-brainer. How hard is it really?

Now those in pharmacy will point to other issues, which are pharmacy problems that I don't expect the general public to be concerned about or even know. One issue is that the dispensing process is not a full-proof system at the current time. Even with CPOE and Electronic Prescriptions, there are still multiple issues with prescribers getting the right drug to the pharmacy. We still are using fax machines, which I often joke we need to have a class on for students in healthcare to understand how to use. Insurance issues (the bane of most patients showing up to the pharmacy) is another, with prices being a constant headache for patients and coverage understanding by prescribers along with requests for prior authorizations and claim denials. This all requires communication by the pharmacy team between providers, patients, and insurers to get medication to the patient. Suddenly a 15-minute wait becomes a 2-day endeavor of back and forths and miscommunication. That's why even with large mail-order pharmacy operations, there are more people staffing the call-center than out on the floor of the dispensing process. Amazon being Amazon doesn't mean this problem will go away. Rather, it's a new area that Amazon is going to have to learn to deal with and address (which hopefully includes a good leadership team knowledgeable about current practice and realities of the pharmacy, or better yet, teaming up with a PBM or similar partner to get into the space). It's not impossible, it's feasible, but we need to reasonable about expectations that the public seems to have.

Second, along with some of these issues, is the regulatory laws in place. This is a branch of pharmacy that most of the population is unaware of until there is an actual legal problem. There is a federal pharmacy law, along with each state having the right to be more stringent. For patients that travel frequently and try filling their medications in another state, this is often where they come across a problem. So, where many are apt to say "Well the Taxi industry never took Uber seriously, and pharmacy is in danger too," I think most pharmacists nod their head with the understanding that it's not an issue of Amazon getting into the pharmacy space, but rather, it's not going to be a cut and dry system that most people expect.

But let's put this all aside. What would happen if Amazon got into the pharmacy space, what could they do differently?

For now, I am going to go along with potential drivers in the Digital Health space and other health care ideas that Amazon could latch onto.

The pharmacy component could be pretty straightforward with a few options, including going into a distributor role (such as Cardinal Health), creating an online pharmacy with a mail order service, or even using the new WholeFoods locations to open up physical locations. Each has pros and cons of services. For instance, a physical location offers the ability to offer vaccinations and filling of same-day needed prescriptions (such as antibiotics, pain medications, etc.) after seeing a doctor visit. Some may say that it could be possible to do 24-hr medication dispensing services, but that may be hard pressed depending on how many centers that Amazon could open and a reasonable delivery time (such as a rural setting).

However, just having a place to dispense medications from I feel would be self-limiting. In an era of big data, how could Amazon tap into a users data flow to find out their health and target specific services to them? Tracking their search histories, online data habits, and the 'golden egg,' their health data from say an insurance company would allow Amazon to do a lot.

Putting this all together, this could be one possible model of how this all ties together.

And, this is an example case of how it could work for a patient that uses Amazon services. It really isn't hard to predict integrating Alexa and wearable devices into a patient life to encourage physical fitness, adding telemedicine services when needed, and just having Amazon address patients health needs via a platform.

So with that, I welcome any thoughts or comments. I am particularly interested to see what else could be done.

So, you're a pharmacist or another healthcare professional looking to update or create some standout portfolio/resume. It's tough, isn't it? I mean, look online for ideas and you will quickly get inundated with so many design ideas. My experience is some of those out there are very design heavy (hence their creation by artists and designers to showcase their work) or just look so normal.

Now, I'm not saying the tried and true black and white resume with one monotone serif typography is something to shy away from, hell, it's probably the most professional one still widely accepted, but sometimes breaking from the mold is worth the risk to standout I feel. However, it's always worth knowing your audience and who you are sending material on to, and going for something that is acceptable at the end of the day should be your main goal.

Starting Out

When I thought about creating a portfolio for myself, I outline several items that I wanted to showcase. Namely, I started with my current Curriculum Vitae and gave it a look over at what I have done and projects I have worked on that I would like to highlight. Since most positions and opportunities I seek center around writing or speaking (e.g. CEs) I look to identify a spectrum of samples to demonstrate to whomever I am approaching about my expertise and experience.

Generally, items I think that are useful to get together before starting out include:

Quick Biography Blurb - This includes a small one liner on who you are or an identification to go with, or a small blurb highlighting your interests/passion/expertise.

Work Experience - This is pretty common, but make sure you cover your title, location, and time there.

Professional Duties and Skills - Highlight skills or knowledge sets. Maybe you have experience in certain areas or skills that may stand out compared to others, like using a specific EHR system, or language skills.

Awards/Honors - If they make sense I wouldn't get too detailed unless it's something that may be outside of the norm.

Post-Formal Education - Certifications or other experiences you have undergone I think worth highlighting.

Projects, Creations, and Accomplishments - Here I think if you engaged in something worth highlighting that demonstrates your skills and knowledge will play to your advantage. These can then be expanded into portfolio items to be detailed later.

Creating A 'Look' for your Portfolio

The next step after identifying what you have to present is how it's going to look. I recommend looking at some samples online, but generally, create a color scheme and choose at least two-typographies. I'm not a design expert, but generally I think a few things can be leveraged to make your resume/portfolio jump out.

For color schemes, some good references include Coolor, a website/app you can use to help create a color scheme of your liking. I recommend giving it a look!

It's Free and Fun!

For typography, there are a few free resources online if you aren't happy with what you have on your computer already. Generally these days there's a lot of options, and one thing you can use to your advantage is that may typefaces like Helvetica or Calibri have Heavy and Light options to help the flow of the type.

Lastly, I like to add logos/icons to my documents. There are a few free resource online to use, like FlatIcon and TheNounProject.

Icons

Sometimes icons can help a reader identify quickly what they are looking at and serve as a guide.

Other items to consider is how you are going to make your portfolio/resume. I've used Microsoft Word and Publisher in the past, but now use other programs. I would love to use Adobe, but have settled on Pixelmator which is available on Mac.

Lastly, there are many programs and references you can find online as guides. I use a website to buy logos and templates from (DesignCuts) and this was one product that was available that I was able to modify heavily to use.

My Example One-Page Resume

So here is my example of a one-page resume I redesigned to include in my portfolio. Obviously, It doesn't include everything, but just the parts I think matter for opportunities I am looking for. First, here is my old version, that I created about 2-years ago, and to be honest looking back on I really could have done better with.

Not Exactly My Best Work...

I've learned to be better over the eyars.

Looking back at this thing, it's just way to busy. I really tried to slam everything I could on one page, and I really do not think I knew what I wanted to put across. This time I tried to go for a more minimal look that I could send along easily.

While the one page Resume I find useful, I created other supplementary material that I put together to flesh out a full portfolio.

Other Items to Create a Portfolio

What else can you put together to create a portfolio?

Portfolio Cover

Cover Letter

Items of Interests (as mentioned earlier)

Here are some samples I have created.

Overall, I am happy with the progress I have made in creating this portfolio. Thus far, it has been useful when working with others looking to see what I have done, or looking for others to collaborate with or work for.

The Issue:

For many presentations I give throughout the year in different programs of my University, my slide deck inevitably ends up being the core study material for my students. While flipped classroom models and use of adjuntive material (e.g. videos/Youtube) have cut down on the amount of slides and time spent in class on cases and material, the slide deck still reigns supreme.

One item I have been playing with is the content of my slides and trying to make the design more uniform in design. Recently, with changes to Microsoft Powerpoint, and hardware changes in the classroom, widescreen slide set-up have become easier. I love the extra space and the ability to incorporate images easier. That being the case, I set out to try to make my slides easier to navigate for my students during lecture.

Building a Roadmap:

Usually for my lectures I present a roadmap of what the lecture will cover and significant events, such as quizzes or assignments expected.

Example roadmap in a lecture about burn and wound care for pharmacy students.

What I have also started incorporating is the use of slidebars into my lectures to allow students to identify the purpose of each slide.

Side bars for a Self Care Lecture based on core content discussed.

Example Slides

Below are sample slides I have created for several lectures where I will be piloting this concept. I will be seeking student feedback if these changes help the students better navigate their lectures and make the content easier to follow.

Note:I have grayed out some slides to preserve material for internal use in my lectures.

Recently I went up for advancement from provisional status. Due in part of my love of trying to make things graphically appealing and as a format to get a story across, I attempted to make two infographics detailing my scholarly activities.

The first one was a graphic outlining what classes I have taught or been involved with during my time at the university.

The second item I prepared was a graphic showing what presentations I have given across the US as well.

Overall, it was a fun project, and I got some good feedback. As to the value of such graphics in a promotion packet I am debating what else to create. One item I have considered would be the incorporation of Altmetrics and publications to detail the impact of the work I have conducted. Another area would be student feedback with the classes taught.

Wearable Sensors, Digital Health and the News

Recently, I have started seeing some interesting items on my friends Facebook feeds and on digital health and technology innovations. Namely, adhesive biosensors and temporary tattoos. It started when I saw a friend online post a tattoo they got that showed their running times in a race (see example). I thought that was a really neat idea, and wondered if it could have benefits with patient identification and other sorts in the hospital or other environments.

In any case, I saw other new biosensors that are being developed as well along similar lines. First, Chaotic Moon is developing biosensors that attach like tattoos. Another company is creating an adhesive biosensor that can detect infections in the blood. This stuff is damn cool. I could see a mix being used to monitor patients with infections and their febrile status or how well a patient is improving.

My Idea and Concept Map

So, working with some of these ideas and concepts being designed, I wondered where something similar could be applied in the pharmacy world. How can we take new digital health solutions, and combine them with OTC medications? One place I started with was Tylenol (APAP), one of the most widely known OTC drugs.

I decided to play with the idea of creating an attachable biosensor for children that could track the body temperature, and send data in real-time to a parents smartphone about their childs status, and could help remind how much medication to give the child along with reminders of when to adminster medications, along with alerts if treatment is not working and requires further contact with a provider. So see the following for my concept:

Combining Digital Health tools with OTC Medications (Case: At home fever treatment in a child)

So, the idea is rough at this time, but I think you can see where I am going with this. In any event, I think it would be cool, if say, a company like Janssen that makes Tylenol would start making such OTC products that integrated digital health tools to provide parents/patients with more awareness and information at the disposal.

Going beyond my idea, I think there are multiple possibilities for Digital Health solutions with OTC drugs, especially as cost comes down and big pharma turns an eye to this area of new development.

Moo Cards and NFC Technology

Moo Cards, one of my most favorite companies for creating modern stationary, just released a new line of business cards today that incorporate NFC technology. The premise is that these cards are capable of displaying information that the user chooses to share on a partners smartphone. Such ideas include:

Digital business card

Shared website link

Sharing social networks (e.g. LinkedIn)

Promote a product/app/idea

Share a playlist

Video chat portal

Share directions with Citymapper

Quite cool huh? Some may say this is a gimmick, but I think it's a good bridge in an era where we can't get away from business cards as part of formal decorum, but our need to digitalize practically everything. I personally would like to create a few cards to test some ideas and concepts, such as a landing page for my website, or even a video to open up with introductions.

In any event, the one thing I thought that may be interesting is how we could perhaps use these cards or similar technology for medication reconciliation or patient medication records. Most patients get discharged on a list of medications, or leave the doctors office with a paper record of sorts on what they are supposed to take. For me, I routinely have patients who record their medications on a piece of paper, or some notebook, that they routinely have to update. What if with a tap of a card we could have a piece of information they could keep updated? I had a similar idea when I saw the 'Coin' Card released a few years back, as a way for patients to keep their medications record in order.

The Concept

So that's the premise. I'm pulling this from my experience of patients that use notecards and printouts to record their medication list. I admire the patients that put the diligence into such apt record keeping, though often the papers and forms eventually are written over and over again they become a mess, and a new one needs to be created.

A medium such as a card could be a solution as a way to open a portal to patient records, and shared at multiple locations, and easily stored in a wallet or purse. That being the case, there are a bunch of issues, such as patient information, data sharing, and how to integrate such data across multiple EHRs and digital records.

We were challenged at the end of MedX by Dr. Chu to think of "how might we" change an aspect of medical education. I wanted to think of how I might summarize my experiences, and think of how to bring this back to my teaching modalities. The following is an infographic of key points I feel resonated the most with me, and I hope you find it of interest!

So time to start day 2 of MedXEd!

I am very excited, but for those that read my previous post on Day 1, a forewarning, this day is workshop oriented, and I wont be in every workshop, so I will be only writing on what I see. Follow the #MedX Twitter feed if you want to see experiences outside as well!

Of course, I'll still cover the keynote and other public sessions!

7:46AM: So, getting coffee, found a seat, now trying to find out what workshops I am attending! Ok so everything is online, and here is my itinerary (based on my selections pre-meeting, wonder what I got!):

1:10-2:40 - Presenter 101: Using presentation software and other digital tools for engaging an audience

2:40-4:10 - Editing Wikipedia for med school credit? You can too!

Well, I got most of the ones I signed up for! Awesome! Some of these weren't to high on my list, but based on yesterdays experience I am sure the content will be great, and I can apply some of it!

Coffee again, and got to chat with an awesome guy from New Zealand (@Stevegallagher). Conversation ranged from digital health, psych, mindfulness, and beer. Love the people I'm meeting here!

8:08AM: Opening introduction by Dr. Chu, great shoutout to speakers. New things this year are the learning labs and deep dives being hosted. He wishes he could attend every session (don't blame him). Call out to follow Twitter (who uses email anyway?). This is an open access conference with live-streaming. Over 6,000 tweets from the meeting yesterday. So many people involved that weren't even here, great example of conference tweeting impact to our colleagues that couldn't be here. Now introducing the keynote speaker of the day. Yesterday he challenged us to forget everything we knew about medical education. Ask lots of questions (e.g. what is.... what does it mean....). Sarah is a visionary leader, of Stanford 2025. Inspiration to faculty and students, and today we get to listen!

8:14AM: Keynote time! Video playing on a trip to the future. This video is freakin amazing. Time machine to 2025, that goes to 2100 with a look back to 2025... my god this is inception worthy. I swear the production value that goes into the work here is amazing! Roleplaying was pretty good. Classrooms give a good insight on how we think students should learn. Enforces sage on the stage, should be quiet. Can not be configured. Encourage to record what we hear for future reference. For respect. This model goes back to the Greek States Forums of learning… The learning environments are so old and ingrained (I’m thinking all the pomp and circumstances at graduation). This leads to an interesting debate on the form and cost of higher ed. Critique of the top tier institutions admissions. Damn to much expected of students these days in my opinion. We are fostering and army of HS students aiming for a small definition of success. Yale speaker has quipped that we are training we are training really good generation to jump through hoops, or really excellent sheep (New Republic article I need to pull out). We have students going into areally disruptive world, and need students to understand that they won’t be our leaders based on their pedigree, but because they need to be our best thinkers and doers. Rise of digital technology is disruptive (looking at you MOOCs). Many were scared, challenges the status quo of medium. We are past the hype, but can look at the hype and potential uses. What is the future of in-person learning experience? Did a process of interviewing to understand the end user (mans, students and user based design seems to be a thing to talk about it seems). Giving example of history student, and how one was scared of major, and took a year off, despite the social pressure. Took a year to work on a political campaign to learn and then came back. Video quality iffy, but message is good! “taken control of education in a meaningful way and in life” Interesting incentive. Doesn’t care for grades, but better than have been! Does more of work assigned, and enjoy it more. Nice to hear, so how do we get more Becca’s with more control over education and their lives. How do students ‘hack the system’ of their education? Sent students into the environment, largest used bookstore ( largely now online industry comparison), Homeboy Enterprise, SpaceX, a lot of interesting elements to pull from. Homeboy showed no one pattern and path, individualized elements. If you can do this in that environment, why not in education. Even investigated Cirque de Soleil – How do they stay sharp over time? Because they are always learning new skills, even if you are the best. Acrobatics take salsa dancing to remain in shape and stay in element outside of the norm. Opens some provocations: 1) Open Loop University (What if you could exercise every day for 4 years and be fit for the rest of your life? Ridiculous right? Same applies to education. We need to change that concept, and education integrated over your life. What if when you came to college you had 6 years to spread over life. Loop in and loop out.) So no longer apply to college, but you are recruited. Huh, video time. Seems like the thought process of start-ups to find and recruit. Changes way how people prepare for college, so that students can be started by recruiting committees. This… is really a disruptive thought. I think admissions would HATE it to some degree. Cool. 2) Paced Education (What if students moved at their pace. Some students are never sure what they want. This industrial process leaves a lot of room for innovation. What if we change the way of student development from coming of age and cognitive development. à Paced education for calibration for what students should actually study in preparation for a rigorous track. Then they dive into a field to learn, and then practice those skills and work on an interdisciplinary team.) 3) Axis Flip (What if college wasn’t about accumulating information but developing competencies. We are never going to live in a world again that we can’t access information again. What if we flip things around from topics and skills to underlying capabilities? Campus becomes focused on teaching hubs. Communication, quantitative reasoning, that can be applied for the rest of the students lives. A new college transcript! No more time/credits, but something about what the students are prepared for. A highly personal transcript! What can a student actually do?!) 4) Purpose Learning (What if students declared missions, not majors? [How can this thought disrupt medicine? Is pharmacy a mission?] What you wanted to study used to be a ‘major’ mission. Requires project based learning. Coupled with other components of impact requirements – impact labs where students and faculty collaborate with local leaders and community workers. Mastery with meaning.

Ok, I need to really come back and reflect on how this can impact medical training and learning. Some of this is cool, and some just really seems out there for me. I eagerly look forward to reading on others thoughts. This is really alot to digest....

8:43AM:Chair of technology hub speaking, apparently will be 5mins of talks going. I will have to explore what they have. Ok, the internet here is SO MUCH SLOWER. No images for now. Osmosis now coming up to talk. So, when does Osmosis come to pharmacy? O a demonstration with the Osmosis Med to demo! Cool. I really think its amazing how much Osmosis has grown over the years. I like the curriculum syncing they have in their course, especially with tests coming up and push notifications. O look a game! Play against each other. I love gamification in education. Lets go word with friends for #meded! Another company, on MedMetaphoria (pun on metaphor I think). Name is hard to pronounce it seems… Psychiatric resident presenting this topic, from NZ. HealthInnovation hub from Auckland. Game being demoed to try. Image of an iceberg in front of Pyramids. Need to dive deeper than treat tip of iceberg. Medical student is a production line. Skills, knowledge, etc. Lots of textbooks need to be crunched by students. Issue is knowledge retrieval. SO this plays on visual cues it seems and helping students remember. To learned and retrieve knowledge at POC. Lock and Key model – Back to drug mechanics. But analogous to working memory to long-term memory. Demo playing. The music choice… sounds like an action movie. Very interesting use of symbolism and game based learning. Now for another company, PicMonic – Visual learning community. Platform to learn and share highly visual pneumonic. Pictures for pneumonic cards. This is not something that comes up for pharmacy education I feel at times. Huh, theres a publication on this, will have to pull it (PubMed:Picmonic/adv med educ) Control vs picmonic group. Now showing story of ebola RNA Rhino, with E-Bowler. Ok, this is a cool case with a straight forward question. Seems like something that may be beneficial over route memorization. 5-FU = Flurouracil (Kung fu guy with number 5 on him). New presenter, on a concern related to the fact that medical people learn a lot and know a lot and still don’t help, some patients come into the hospital and get worse. (To err is human I suppose). Errors and thoughtlessness can have a major impact on patients. How do we help people experience a situation that can have serious outcome but without actual damage. Simulation. Shows image of waiting room (for most its not a fun time). Now shows a simulated waiting room, we can use tech for this purpose. Seems like an old idea really… show me the innovative factor. Being used at the University of Buffalo. (I swear, when the game industry gets involved in this realm, it will be amazing, why aren’t we partnering with them? I mean, Destiny had a half billion budget…). Simulated experiences needs to be 1) Realistic, 2) Challenging, 3) Brief. This helps it fits the workplace and recreate their environment, represent a typical crises and pushes out of comfort zone, and if make mistakes can finish and repeat and try again and again to relearn. Example of sepsis (which is a critical disease) with 5-mins cases with different angles. Experiential and realistic learning. SIMTABS LLC was the name of this product group. Next up is another presenter… Where is he? O there he is! Hey wait… isn’t it workshop time? Ok, Im going to take a look for a room for workshops… not sure if I am missing something here. No announcements. I can come back and look at demos later….

9:25AM: Ok, so it looks like we are just running behind, and that the workshops haven’t started yet, so I am just gonna chill out here and get coffee until the workshops start. Shame, was confused about that, and seems a lot of others were too. Ill have to catch up on the product(s) I missed later. That includes Figure 1!

OK, my new invention, conference tables with power plugs with a nice centerpiece. Not enough power I swear.

9:35AM: So found my first workshop! Time to see about interprofessional education and interprofessional care. They are still setting up. We’re outdoors, under a tree… interesting. Stil WiFi Issue. I think that’s my only complaint so far at this meeting, but then again they have us at a different building than yesterday.

First Workshop

9:39AM: So the workshop is going to start early, people still missing. OMG being outdoors maybe not the best, we have construction across the street, need to yell, I think the presenters are doing their best though! This is awesome, meeting the people behind the Vanderbuilt program that was showcased yesterday! Im so happy I got to see this session! Oooo buzzword "Extreme Team Care!" I feel there needs a logo for this. Doing some talks on people backgrounds. Really nice to see different backgrounds, PT, Social Work, Pharmacy, MD, etc. I am hoping to see how they put together their program, and the barriers that they overcame (or didn’t). A lot of people want to see how integrated with students. Nice that they are asking for expectations of the workshop. Be curious how to assess interprofessionalism. So we are going to go through the journey of this group. They are asking what we are doing for IPE and concerns. Ahh, so this was a grant funded initiative, along with support from multiple schools. Clinic came from housing industry for patients that were getting sick who were not able to stay in sustained housing (so this is a lower socioeconomic clinic background) which was looking for some level of care for this vulnerable population. This makes it a very interesting environment then. 1,300 patients for 3 exam rooms… Must be very creative. Lots of homelessness and post-jail time in patients. Not to get political, but uninsured also an issue in this state. Their team is NP, Pharm, Social work, Physician, RN/MA, Patient advocate, Clinic administration. Seen many students, mainly Nursing, Pharmacy, PA, even law and divinity. Team is made up first year med student, second year nurse practitioner student, fourth year pharmd student, and second year MSW student. Cool, nice broad range. Ooo, there is some acting on the video due some personal events (short coat vs long coat for actors and actual profession). Steps of a visit student led being shown with a video:

Social work student completes social assessment

Team comes in with translator if needed, everyone introduces each other

Examination done

Then students give their thoughts to medical team (preceptors) along with differential – Students play their roles (pharmacy student about OTC use and care/MD student on assessment).

Faculty then goes in and confirms clinical findings

Then rediscuss as a team about patient case after confirming case, Pharmacy gives thoughts on treatment, discuss follow-up

MD comes back in and implements plan with students accompanying

Using the Toronto Model. Got a handout, will try to post link.Got a handout, will try to post link. VUSN population health model, Team development measure, Qualitative interviews. A lot of models online. IPE merged with IPCP (WHO 2010 and IPE expert panel 2011). Exposure, immersion, and competence go into this model. Students include those that are part of VIPL and rotation students.

Challenges faced:

Institutional

Lack of other institutional collaborators

Practical issues

Faculty development issues

Assessment issues

Lack of regulatory expectations

Interstate variability in scope of practice

Similar problems with other schools. The pharmacy school takes rotation students at site (16 per year, of 43 means that they are taking other students part of VIPL). The faculty member also has a pharmacy resident to cover days he is not present. Food for thought. The clinic uses a lot of students. There is always a core team, VIPL come once a week, some students there everyday or only 2-5 times a week. A lot of grant funding. Is there training prior to coming to the clinic on interprofessional? VIPL handles that. VIPL doesn't want defined roles, priority is patient needs, and system needs broadly. Deep skills come from curriculum (this all from VIPL rep here), Not giving didactic role at the clinic, showing how skills overlap and shift in the clinic. Lots of team meetings and conferences to understand each other and be integrative. Grant money is done, but schools are paying because the success has been so positive. They are looking at scalability of this program -- can it be applied at TOC? May be interesting...

Keys to success:

Initial immersion retreat

Intentional and planned 'time outs'

TDM (team development measure) and qualitative interviews to 'take the temperature of the team'

Other thoughts on model. Overview of traditional, where patient --> NP/MD --> adjunctive team members (Pharmacy, social worker, others). Did a PDSA approach to improving flow, Forming team --> Develop data work flow --> Interprofessional workflow --> Evaluation. Lots of meetings and work huddles I feel went into this. Each profession leads at different times during the patient case depending on needs at different times. Goes into workflow.

Now a video breaking down the steps of the approach.

Social work first. Student interviews patients. Social history. Health insurance issues. Go over any other needs for the day. The duties help: Builds rapport, awareness.

Initial patient review by students

Initial brief with team going over patient. Includes students involved in the case. Structured patient presentation by each student. The faculty push the students on normal practice round activity thought processes it seems. [My observation] This seems to work only when faculty work together to push each others knowledge and students thoughts. Could be easy for one to dominate overcoming each others roles.

Provider confirms student findings. Faculty see patient without the student in this video, or is at least leading the conversation themselves. Presenters confirm that students are there, but gives them a time to observe the actual practitioner.

IPCP Plan Formulated. Team reconvenes and goes over plan. Social worker is present as well and others on the team. 'Time Outs' are key. Other work occurring during this time (lab work). Students go over plan, with the treatment.

Wrap up time/closing patient visit. Being led and overseen by faculty, in this case the pharmacist is ensuring the patient counseling. Non-pharm also discussed. Social worker comes in and activities.

[Optional?] Phone Consult with Physicians. Goes over patient. Such as labs and discussions of problems. [Could you use teleconference? Suppose be more $$ and difficult in this environment]. I would think that the MD/DO assigned to this must be key in order to be willing to oversee or coordinate care. Seems interesting with the fragmented health system environment present.

Complex Case Review. All come together in the team (students and faculty) discuss the case. Looks like presenting an ongoing case, kinda cool that maybe those that didn't see can ask questions, and updates shared.

Closeout: Awesome presentation, the presenters did well, and theres alot of food for thought. Looks to seem several pubs coming out of this. Need to look up "Interprofessional Touches"

Workshop Two

11:15AM: Time for the next conversation! Presentation Makeover time! Get rid of the bulletpoints! Talk as a speaker. The images are fluff heads to make the points stick better. Get ready of animations and things flying around. There are alot of things in PP that fluff it up and we think make it better but can really take away from the presenter and information. "People who know what they are talking about dont need PP" ~ Jobs. Use your hands and emotions. Watch out for the carnival duck (the presenter who walks around bowed over). He's going over normal presentation style. OMG I LOVE THIS> showing an image of King speech, in PP format:

Free at last!

Free at Last!

Thank God Almighty,

We are free at last.

Yeah... Really doesn't look good in bullet point format. He's showing people and famous speakers and design. Neat books, presentation zen design. I should look into it. Multimedia learning another book being mentioned. Really should look into this. How to make slides that keep you awake and to learn from.

Slides are a form of teleprompting. Stop that. Images can help possibly. Kinda interesting, going back to early businesses on education, this can come back into teaching/learning. Can we help them learn from it. Find high resolution image that just looks nice. Then go around the world and talk about it. We should know the material anyway. heh, Speaker calling out he's not teaching. Rather we need to learn and change thought. Ok, I call out this article and recommend it "Let there be stoning" by Jay Lehr. Slides need to be intertwined with teaching. This session is more on just talking to students and teaching, not quite on methods of avoiding slides necessarily.

PowerPoint is not a talk. Make good titles. Deadly signs of chest pains vs Signs of Chest Pains. Some discussion on how to put in images of data. Powerpoint smart art is not necessarily a good thing. Some things can't be avoided if you are forced to do things (CE's). Book on 'Slideology'. Some people say slides are now a document. Presentation vs Document. Takahashi Method (look it up) being mentioned on terms of presenting. Large Fonts and Simple words. Another one is Lessig Method. Words appear as he talks about it as he gives out a mapped talk. Storyboarding can help change how you do slides. For instance, what is the story you want (map out talk), and then imagine how you would show it. Key points = slide element with visualization. Freemap with pen paper to do this, or even just use Post-Its to map out a presentation.

Your slide set should be the last thing you make when preparing a talk or lecture. I like the concept of mapping. You can even just map on your slide deck, say 'put image of ____ here.' Also, don't force humor.

Other thoughts:

Don't read the slides.

Animations. Do they really add things? Can be distracting.

Captivate. Tell stories. (My thoughts, cases as stories). Book - Made to Stick.

Video can help. Frame the situation. Go go GIFS!

Use Pictures. Use them smartly. Cognitive Load (only so much capacity)

Ok, overall, I liked this presentation, its inspiring (which I think is the goal) but Ted style talks are good for thought, not doing. I think I can look into the references he mentioned (again his point) and read up more. Glad I attended.

12:12PM: Lunch time. Need to recharge Laptop, time to find an outlet! Met some of my favorite people. Quite fun!

Workshop Three (Similar to Last One)

1:15PM: Finishing lunch, starting next section. Huh, its Rob again from last session, not to bad I guess! Presentation Tools for Educators. Always look for the one person in the room smiling at you. FIND YOUR CHAMPION! Go to that person that is your 'pick-me up.' He's reviewing some material from last session I attended. Time to upload some pics I suppose. Ooo Cognitive load again. I swear that is something I really need to update on again. Need to stop death by PP. Our sole job is not to deliver content (ideally a presenter knows the content). Rather to inspire learners to go home and self-learn and drive yourself (I think I know alot of educators may not feel the same way, but the argument at MedX [which I agree with] is that the world is changing). Alot of this advice is to inspire to greatness. Heh, don't let your presentation be corporate. Students shouldn't a corporate product. Goes back to earlier speakers of how to develop a student. O, E-Patient Dave is here. Good question about content and the load of information across slides. Rob is striving to say to use slides to get people to pay attention or drive to learn further, and that mobile isn't always a fear. The speaker is the message, and the slides help back it up. The more you add on the slide, the higher the cognitive load, and the listener will checkout. I swear, I want the slides he has about death due to PP. Some good ones he's showing. Rob wants to end bullet points, but some places still need it (lets say when translators or involved). Some audience likes bullet points, as a guiding point to give the talk, to remind about key points, But Rob arguing (again) drains the listener and can engage the listener differently with other medium. Rob likes Keynote, alot, benefits is simplicity and incorporation of videos vs PP (but makes your file hella big [good luck emailing that]). Simplicity helps with presentation design, and pointing out that PP has alot of perhaps needless items. Do we connect the message with the slides at the end of the day? It's about connection. Challenges members of the audience to review their slidesets. Does the message purport simplicity [Now, I did talk to Rob after last lecture, about lecturing on pharmacology, and some things may not come across well, but perhaps images on the item can help such as the pharmacological mechanism]. What does your brain want to see up on the screen to get the message? So, are slides a document for your content, or a prompt? Or maybe it's something more. O, he has a cool item, its a tweet adjunct on his presentation called Tweet While You Talk (#TWYT), in order to work you need WiFi and the add-on in presenter mode. There is some shorthand code to do this [Tweet] content [/Tweet]. Just be careful, program not that smart, going back and forth over slide will spam followers. Now he's talking about Prezi. [Personally, I'm not a fan, makes me motion sickness and too much damn work -- Though Berci used it decently yesterday]. Pointing out that too much movement isn't good, maybe just alot less would be good.

Yeah, see this just looks like to much work. Not a fan personally. Seems to override the simplicity model being addressed.

Ok, You know what? After listening to this topic for the past two sessions, I have to ask:

Did PP make bad presenters?

We want to return to the age of presenters as the center of speaking to back up information (but then again we are seeing alot about the deconstruction of lectures and group-work). In some ways remind me of old universities.

Another question I have is if the need for more 'entertaining' presenters with personality is what is needed to grab modern learners (e.g. Millennials)

Ok, anyway, PP vs. Prezi, PP wins. Though speaker supports Keynote more. Though audience members like it, to show connection, and zooming in on aspects. Now showing another slide from Prezi, saying alot of work, and pulls away from speakers message. But now showing one that is decently well done, but I'm still not a big fan. GOD THIS LOOKS LIKE TO DAMN MUCH WORK. Heh, one member of the audience really doesn't like seeing this. Prezi has a free trial, and runs about $60/yr for subscription. Now up is PowToon. Good way to advertise, but may be good to teach simple concepts. Way to whiteboard your message. Free 1-month subscription. Rob says uniformly that there is a wow factor, and people like it. OMG... $57/mo subscription. Audience saying there is a free educator account for a year. Will have to look into this. Another audience mentions 'Crazytalk.' Can put music. I would recommend Google/Youtube Free music, some I really love. Hmmm, Ok, I could see some use of this for flip the conference or classroom items. Good question from audience member about images (and thats a question I have about image rights, I hear so many different things on CC licenses and such -- wish he'd talk about it). Slides [Beta] is a simplistic design presentation tool. Templates are kinda cool, but again, is this distracting I wonder. But, the slide decks seem very professional, I think you can be picky though. Linked in with SoMe areas. New area is Videoscribe service. It's $16.50/mo and annually its $198.00. Try the free trial. Allows you to play with a blank canvas. Allows you to make a video and items. Audience ask what Khan Academy uses -- Wacom tablet. Meh, my hand writing isn't that good. Don't forget the power of video [Gunshot wound video], emotional charged video can pack a punch. Anytime you activate a learner, the more you take away the cognitive load. I like that comment... Personally I dont use alot of video, he recommends SAVEDEO. Interesting, a way to download videos (its a converter). Heh, the Nail (in the forehead) video.

Rounding down, your talk is not about your slide set, it's about you. Have a story, have good eye-contact. Slides are just a small part of what we do.

I do enjoy his talks, be interesting to see him talk to pharmacy schools. [End 2:23PM]

Last Workshop of the Day!

2:51PM: Bring on Wikipedia editing! No COI. Interesting that most here have positive thoughts on the use of Wikipedia. After all, isn't wikipedia for all free medical knowledge? WE all use Wikipedia, let's not pretend we don't. 8K views per second. Non-profit based in SF. 200 employees. There are (dated info) 180k medical articles and ~>5billion views annually. More than NIH, WebMD, Mayo, NHS, WHO, UpToDate. I like to use Wikipedia, and have students compare its information against other sources, always a fun thing, after all so many use it! WIkipedia has a grading scale. And they have ranking for medial as well. Reminds me of what goes into a guideline. Best article [Tourette Syndrome] vs Stub [Acute Care] and B Rank is [Tuberous Sclerosis]. Now he is bringing up WikiProject Medicine. I've always admired this group, though I never have thought of dedicating any time to it. Oooo... Importance scale, readership and global burden of disease. Such as Dengue Fever [Huge burden, but not much readership in US/Other developed nations], or Human Sexuality. Now we are gonna visit WikiProject Medicine. Now talking about Wikipedia Zero - Pull Vimeo Video - its a nice video from those around the country. Phone services are offering Wikipedia for free. Schools don't have a library. But many do have cell phones [echoing my belief that the digital divide is disappearing. Digital health is something I really want for those that are vulnerable]. He is putting a callout to academic partners to drive the thought process behind wikipedia. Now he is talking about activities at UCSF for and elective credit. Audience question: how did students choose what topics to tackle? Presenter, he ask students to pick one article and work on it all month, but he encourages students to work on a low quality article. Some students will work on topics that they find of interest (e.g. those interested in OBGYN went after those topics). E-Patient Dave throwing out where patients can play a role. Presenter - Students found this a challenge more than they anticipated. What do they as future physicians determine what to include for others to read? The lead article top part is the hardest to write (e.g. the jist of content). The meat and bones tend to be easier to edit. E-Patient Dave again throwing out that patients have better knowledge of potential studies under way (due to their searches), and how can that be worked out? Editing Wikipedia is harder than it ever was. The problem is that Wikipedia wants knowledge widely accepted, and that clinical trials is difficult due to depending on where it stands (Fact: there is a clinical trial, but need to remove the emotion behind it). O cool, he's handing out the glossy stuff on information now. Need to look up the Wiki Edu - Wiki Education Foundation - Partnering with educational areas to help partner and teach with wikipedia. Beats wastebasket assignments, and helps students build meaningful content. Can log in and create course assignments related to Wikipedia. Wow, there is alot of work to get educators in medicine to help with content! E-Patient asking is it now less often for patients coming across wrong data on Wiki. Hard to answer. Audience chatting on how the accuracy is better now, and call on the view for us to update it is not less fringe theory. There is more overwatch now than in the past. You could delete the section of Cardiology, but would probably be reversed in 5 secs. The controversial topics are higher risk for vandalism. This is prevented by automation, quasi-automation, and editorial oversight. Move from digital consumer to digital contributors. Physicians have been first to denounce information that patients to consume, but last to help solve the problem. NASF is giving grants for science and digital modes for creation. Mention of @FredTrotter, who is now speaking. Topic moving towards open access of information. Aaron Swartz comes up now and the MIT issue. Giving example of ex-wife who was a medstudent who was using wikipedia up to a point when the data was no longer relevant. This led to a Robert Grant to look into how students are using wikipedia for #meded. Just got IRB approval. This may help to identify where data is relevant based on browsing history. Let's find where the right information is, and what needs to be fixed. This then builds a feedback loop (e.g. bug tracking device) that MS1 & MS2 find an problem with, that then MS4s can go back and improve. This loop could help fix alot. Gott in Himmel this is cool. Should see if pharmacy students could do it. Heh, blue numbers, good way for us to see a side by side where things are comparing. Looking to work with Cochrane -- come out with review article faster to ping the author back faster and keep it updated indefinitely (will probably take 3 years no matter to make the article, but lets keep it updated). E-patient dave putting out that many docs think that Wikipedia is crap still. Presenter is trying to publish to address naysayers. Hope it gets through review. The Dengue Fever actually got published retroactively as an article. The Ebola Crisis there was a push to make it a good article status, and then translate into those facing crisis. Audience member about Cancer.uk trying to push the authenticity of Wikipedia. Some are encourage that as you do a systematic review that you also go and update Wikipedia. James may argue that some researchers and writers are pirating Wikipedia content as their own. Concern about citing a webpage as it changes vs traditional that stays still. Argument about learning to cite a specific a version- which is citing a metacitation at one point in time. Wikipedia is a constantly evolving beast. Bias versus high quality and enlightened data. A clinician may see something different than a patient in a wikipedia article. Say a patient cant understand diabetes from their provider. They look at Google, WebMD, Mayo, but then advised to talk to their doctor (which they have the issue with), versus Wikipedia just gives a link to too much depth. Wikipedia can give a runaround, for good or bad.

Thoughts: I love this talk on the nature of research and data that constantly evolves. Is Wikipedia the best for the future of medical data to be spread as we slowly get away from textbooks, we embrace databases like UpToDate or Dynamed, will Wikipedia be the end all be all product we all use?

4:15PM: Breaktime and coffee time!

4:22PM: Closing Panel time! So, those that stayed till the end get M&Ms with Zoey on them, no longer the speaker faces (was a bit odd) and a card to fill out on 'how might we...' do things differently. Now panelists are chatting. Going back to Coldplay's song yesterday we are stars. We are here to explore new ways in medical education. Panelist is curious how far we have moved from ideation to action? What new ways of thinking did we bring back? MedXEd is changing alot of how we need to change medical education. How to evolve courses and thoughts. Moving to interprofessional training. Not just silo education. Information management is also key. How are we gonna manage the inputs? Some thoughts on the Wikipedia editing functions, harkening back to we criticize on the information available but need to offer more of our patients, and the world at large. Other panelist thoughts, we need to go where the learners are. We need to occupy in some sense the spaces where the learners are comfortable in, where current educators may not themselves feel comfortable in, all in order to create a collaborative learning environment. In some ways how the classroom is online. But it is very complex to merging the online and in-person learning opportunities. We need to listen to students just as much as we listen to patients. Next panelist, good to just meet people and finding similar ideas and problems to be solved. How to get students to lectures? Why are we trying to control how our learners learn, why are we trying to upset how learners learn (e.g. mandating attendance by swiping in). Dr. Chu highlights are how we are flipping the paradigm by having patients add to the training of doctors curriculum design. And how this can impact patient care which is the ultimate goal. How do we train and nurture the next generation of students. Alot of innovative students coming up with technologies to meet the gaps that they see in their curriculum because it's not being met. A shadow curriculum is developing. MedX embraces inclusivity and create such an environment, and prototype it. We cannot get T3 evidence for everything we do in the curriculum but things need to change as well. (Remembering the references to the parachute study). Another panelist points out the connection behind e-patients and students. We may need to pay more attention to them than given credence. How can we increase one-on-one with patients to increase learning, and how it disrupts medicine. What are we going to do when we go back? Panelist Bryan saying he wants to bring Wikipedia back to their institution, and bringing more interprofessional education. Heh, good joke, Dr. Chu will strive to work on MedXEd 2. OOOooo, panelist is launching minor in medical humanities, and will get students to help design the curriculum. (I love the idea of bringing the humanities into the medical education). Humanity (or the art of) is at the heart of medicine. Technology plays a large role of this conference, but tech will come and go but patients will remain. Technology is just another tool to foster connections. Its new and foreign and scary, but the essence is about connection, and need to not be at odds with each other. This is relevant as technology replaces more and more what we do. If a machine can replace it, then it wasn't very human to begin with. Huh, the human computer interface is being brought up by another panelist. Let us look forward to next year!

Bonus! Got a picture with one of my favorite people to listen to!

So this is going to be my attempt to take notes and live blog my experiences to the MedXEd Conference at Stanford. In all honesty, I'm greatly excited! This will be my notes of my experience, and some musings. I will condense it in the future.

7:54AM: Lights are darkening and now the intro video is playing, bring on the inspiration. Yay Coldplay (You're a Star)! The story snippets are quite interesting to say the least.

7:58AM: Hello Zoey, the MedX Mascot. Was wondering what the dog was! The video introduction to the day for announcements is really well done I must say. I wonder how much goes into the production of this event. I like how they are pushing for collaboration. And the push for engaging social media is really a positive item!

8:01AM: Stanford Anesthesia now introducing Dr. Larry Chu for the meeting! Gonna take some notes on what he says (note I probably am going to miss some items): Its been 4 years since the conference launched on the intercession of digital and medicine and healthcare at large. Now the most discussed medical academic conference in the world. Stanford MedXEd is the newest conference venue off MedX to explore an area in desperate need of disruption: Medical Education. I would argue that healthcare education in all a professions can equally benefit. To integrate new technologies into patient care of tomorrow relies on the teaching of todays up and coming practitioners. WE are teaching in silos. REAL healthcare is not siloed but collaborative and with a global community with diverse stakeholders. Empathy and innovation rarely happens in a vacuum. We are in a room of educators, technologist, industry representatives, students, pharmacists, providers, nurses, we need to learn from each other and learn. Be uncomfortable, humble, and co-create the future of Medicine Education.

How might we rethink the way medical education is done?How might we use the modern affordances of technology to engage new learners?There is going to be alot of 'How might we..." ideas I feel across the next few days. My goal is to see how we can use this in pharmacy education.

Theres going to be alot of themes, from perspectives of students to patients, with speakers across the world. I am excited for Theme 5 on lifelong learning.

WE HAVE GLOWSTICKS AT A MEDICAL CONFERENCE!!! (Now some EDM would be interesting...)

Larry is wrapping up the introduction, and giving thanks to advisors and members. I think its amazing how much this event has grown over the years.

Bertalan Mesko's new Book "Medicine Upgraded" is book of the meeting. Good Job!

Now on to the main events! Keynote time!

8:15AM: Opening Keynote for the inaugural MedXEd conference: Cancer survivor and author Howard Rheingold (@hrheingold). Notes as follows on his talk: Some may date virtual communities back to 1999, but Howard goes back 30 years, with the purchase of his first modem ($5!!). "Virtual Communities" by Howard Rheingold - Whole Earth Review Winter 1987 (I need to find this!). Story on how his daughter had a tick, and his wife called the office pediatrician and waiting for callback. But Howard went on the 'well' online and reached out the online community. A physician online got back and helped instruct to get the tick off before the physician on call got back to them. This is an interesting story from a time where I was only a few years old! Discussing early forms of support group online made up of survivors, physician, nurse all in 1985. Unfortunately, cancer claimed a life, but people showed up that only knew the patient from online. Now discussing his own experience with cancer. Started a Tumblr on his experience. Writing was cathartic and helped to deal with fears, pain. Social media really helps those that they may not meet IRL to find support. Really great for those with rare diseases (which I think is a big strength of online communities such as PatientsLikeMe [PLM]) and the ability to 'Google.' People becoming more informed and more misinformed (Digital health literacy callout - Everyone is an expert online). Callout to participatory medicine (Society of Participatory Medicine) for patients and for healthcare professionals to get into. E-Patients or Connected Patients. Yay! Now he is talking about PLM. Clinical trials, and example with Lithium. (If you havent seen it, look into how PLM is teaming up with the FDA and Walgreens!). CrowdMed shout out for crowdsourcing disease treatment. Technology helps us crowdsource solutions and diagnoses. 'The e-patient is also a networked patient.' Amplified by technology and information sharing. Peer support is important (and sometimes I think this is something tech cannot change, and why 'soft skills' are needed in the next generation of healthcare providers that are heavily invested in digital technologies.) Futurist indicate driving forces is online searches and the issue of uncertainty. How accurate and trustworthiness is this information? We have the opportunity to shape that.

Pitfalls of E-Patient: Cyberchondria, BadInfo (crap detection failure) - can we separate bad and good information from each other. Overconfidence - so well informed that they dont know what they are talking about (Mark Twains quote comes to mind).

E-Patient Opportunities: Education (good for patients). Learn (example of early HIV/AIDS patients experiences when they knew more in the beginning than healthcare practitioners).

I think bringing this all together is the focus that the patient is key and the opportunity to amplify your knowledge through support networks. Where does this go in the future? There will be only more medical information online (Google is going to give approved pages on health information). O, neat idea, health webrowser - Could it be an extension for Google Chrome I wonder? Don't let natural sceptism become your natural default.

Good keynote! I really enjoyed it. Time for a cofee break. Glowsticks time! Start back at 9:10AM.

Coffee Break Time: Well, this is cool, some companies are doing tech showcasing. Fig 1 is here! Just talked to them about making a section for drug-induced reactions and side effects, would love it!

I also met Kelly Gringrod, a favorite of mine from Twitter! It's amazing to finally meet and chat face to face!.

9:10AM: Time to move on to first session. "Autonomy, Access & Patient Engagement." Interesting story on adeptness of patients with technology shame and embarrassment with the use of technology. How are individuals struggling with VRI? How are students being taught to engage with patients with disabilities? The national association of the deaf put together a list of concerns about VRI with patient outcomes in care. What litmus test is there for patient success? Deaf people having the right to decide and engaged in medical training/programs. There are a number of physicians nationally that are deaf and hard of hearing. Students with issues in hearing also have difficulty in schools. Many are denied schooling. Minimum access does not equate to patient autonomy. Engagement/Education/Ensuring - are these available to patients, and could be a litmus test for communication means and success of access for patients. Recent story about his experience at the clinic. Waited an 90mins for the clinic to find a computer for VRI, even though did not want it. Failure to engage with patient on what they want/need. Good image example of mazes. Navigability and patient autonomy for patients and their care. Note: This is the first time I've seen a presentation given with sign language interpretation. Very inspiring.

9:22AM: OSMOSIS. I remember looking at this app when came out with iMedicalApps. Nice to see how far they have come. "Learning is misunderstood" - nice quote. THere are more analytical power in helping you find what show to watch on Netflix than helps you what to learn in education. I'm not going to go crazy taking notes on how Osmosis works, but those that are interested I recommend going to their websites and watching their videos. My personal question is how to expand this services and material outside of a medical school and into the pharmacy schools. This is key especially with the big push for case-based learning for pharmacy education (especially in therapeutics). Space repetition being discussed. If you are continuously get reminded on material you remember longer. Also, memory association (this persons name is "Baker' vs this person is 'a baker').

9:28AM: Dr. Khullar talking about empathy and the importance of sitting with patients. While listening to a patient talking about their life so much going on, and did not return to talk to the patient later, even though promised. Acknowledges no excuse. Vowed to spend extra time with the patient the next day, but the patient died overnight. I like how he talked about his mind rushing on what is going on and what he needs to do. A checklist oriented mind. Wonder if mindfulness would help in these situations. Empathy efficiency tradeoff versus a business minded health institution. Average patient spend 8mins with a patient. Less time than walking around or documenting. There is a dissociation with patients now. I know many pharmacists that wish they could spend more time with patients than just dispensing. I think this issue goes just beyond the hospital, and into the clinic, and other health institutions nationwide. We don't have alot of time for compassion. Good story, really enjoyed it.

9:33AM: These millennial learners. I can relate as a millennial educator and practitioner. I like how she is starting with a case. Information is taught as indisputable fact. Hard to draw conclusion or inferences from facts. So why do we need iron for hemoglobin? Many students are turning to humanities to learn (especially in pre-med). Humanities versus sciences. Creativity is important. Ive heard some students express this in other institutions about the teaching of medicine and science and that students learn to think on own or that creative aspect. We need to encourage students to apply what they learning to real-life situations. Encourage creativity. Bring back the identify of me/we to the work. Increase problem analyzing skills. What do I know about this problem versus what is the answer. Increase creativity to learn and critical thinking.

9:40AM: Time for the panel on Millennials.Really enjoying this chat and how students are seeing what their struggles are. What's interesting is my experience 5 years ago in school and those now coming in and their struggle. Students are very different in such a short amount of time. interesting to see pre-med, student, resident, new practitioners. New MCAT has different emphasis on different information. Interdisciplinary approach going on. How do we get residents and fellows to learn throughout the day and not get burned-out in early practice. Pre-meds are using the content they are given (videos/materials online), but while studying for MCAT turning to online material to helping to learn. Alot of self-foraging it seems. Shouldn't we be teaching students better foraging skills? I like the call out to Khan Academy. Purpose of medical school is to interact with patients, and that we can tech to learn online. More flipped classroom, less didactic teaching. Captioned videos, why not more accessible technology can learn from? What tech can we give students? YouTube captioning = Crapshoot. Knowledge isn't so patriarchal but rather crowdsourced between students. Students are being creators and curators. Can we collaborate between professors and students. How accurate is the information students are finding? Good example: Wikipedia. Good shoutout that we need interdisciplinary education for students to prepare them for real-life practice. I would like an interdisciplinary panel though, where are nursing students, pharmacy students, PA, PT, etc. Note: Depending how you interpret what the panelist are saying, it can sound insightful or complaining. I think this is the struggle with the millennial generation.

Break Time! Getting to meet people I've only seen on Twitter!

10:20AM: Video time. Accidental doctor. Love it. The importance of Design Thinking. Student from Amsterdam. "The Art of Medicine." How art can be an additional source of communication. "Hacking Healthcare" using art students working with med students to learn from each other, on empathy and knowledge and other sources of information from patients. Love it. Students learned to see healthcare has lots of opportunities for design and art. The assignment to humanize the psychiatric care. Alot of work through experience to foster more human contact between staff and patients. Use design and art in care.

10.28AM: Bring on E-Patient Dave! Give Me My Damn Data! I really enjoy his talks and his experience. He's sharing his work and experience. I love the fact he's a visiting professor for Mayo now. Reference back to Tom Ferguson, MD and his "Health Online" Book. There is crap vs gold online. BMJ 2004 Tom Ferguson "The First Generation of E-Patients," should reference this. With the wrong paradigm cannot draw the right conclusion. ACOR --> Smartpatients.net. Referencing his essay from the BMJ two years ago. Patient engagement is a natural extension of medicine as a cooperative science. How are we altering the curriculum to meet this? Is this a paradigm shift? What if future practitioners are missing out on future reality? Now talking about Watson, and if using literature that may not be accurate or even true. Dissemination of knowledge is difficult. Now he is hitting hard how long it takes us to disseminate knowledge into clinical practice. This causes poor patient outcomes, and diagnostic errors. How to avoid problems? Pay them more to be with patients. Elevate nurses stature. (I want a positive plug for pharmacist at some point, heh). Belgian government is spending money to discourage Googling symptoms. I should pull the video and see what's it like. It's not that patients know best, or overt throwing clinicians. It't thats access to useful information is different. #patientsincluded

10:48AM: "Lecture Halls w/o Lectures - A proposal for medical education" NEJM. This section is about rethinking the medical school. No more "Sage on the Stage." Other article of "Medical Education Reimagined: A call to action" Academic Medicine 2013. Knowledge is science based, interactive, compelling and pt-centered. Based on a Minimum Foundation and 'Evergreen" then interact in 'deep dives' via labs/bedsides/movies/patient care. Experience = true learning. RWJF is reimagining medical education in a flipped classroom manner. Centered on medmicro and ID. I am liking this talk, really good walk-through. I think worth seeing how we can use this in pharmacy education. Bring the patient in the middle, with the science and case. Narrative and springboard videos. <10mins in length. I really like the snippets that is modular and can be adaptable for the curriculum and any changes. "The one world School House." Look into it.

11:00AM: This is a different talk, on a different approach to creativity. Failure is sometimes good. Getting people together to make money and do good for the world. "The biggest missing workforce in health is the public" Susannah Fox shout out on peer-to-peer healthcare. 2/3 or health problems are in the home. Not in the clinic or the hospital. Stories trump data, relationships trump stories, individuals trump organizations. Evidence Based stories are key. His work is similar to the work on YouTube by those that draw on whiteboards and tell a story. Infographics are good. Whiteboards are just one small nudge (I like the fly/urinal example) for better patient outcomes and teaching and changes in incentives. Authenticity is key to get engagement, trust, and buy-in. Expect failure (but financially I wonder how much your allowed to fail).

11:15AM: Superstar panel time! Often times those leading the way are disrupters. "Teach me how to Teach" Learn the language of medicine. Learn to speak and translate it to patients to appropriately engage them. Where does the hospital end and the rest of society begin? One panelist is encouraging physicians to go into the community and 'be that patient' through experience and visualization. Think home health care has some value here, and harkens back to the era of the black bag visiting physician seeing the patient in their home. "Parody Error" - Ept Dave is how do we engage pts to do things, his stance is how do we get medicine to listen to us, and keep the patient the center of things. Shoutout to Health Literacy Missouri for consumer friendly terms - "Clarity is Power." Some patients, not all, are willing to help. Jumping ship now to about the educational gab between students and practitioners. Analogy of the bridge, that as the med student crosses the bridge to a practitioner, remember that you came from a side patients are on. Patients are now helping to interview on future medical students - thats really interesting! Patients are helping with the curriculum design. Pts are encouraged to fill out student evaluation forms for student assessment. I love the line about patient care "There is no cure for IBD... The patient says can you add 'Yet'." Dave adds that pts want an end to symptoms, which is what the patient wants and not necessarily a cure for the disease. Living with not cured. Now turning to student who has a startup, what support did the medical school give him? What support do we give learners who are innovators. Joke "Stay out of my way." I think this echoes Christina Farrs article about drop-out medical students. Hacking healthcare vs hacking university. Kinda an interesting thought, what room is available for start-ups to change the way we teach I wonder? O, I like this analogy, that the student is the user, and similar to how businesses are focusing on users/customer, then that the user is the first case for a user friendly design (UX/UI). We really want radical ideas and innovation.

Advice on innovation: Get paid by a bunch of people for same product (university, hospital, patients), fail (iffy on this), stepping outside of education/medicine to get a different team to rethink approach, Do what makes sense and not what has always been done. Healthcare is the biggest business in the world, and there's alot to disrupt.

Another Break! Off to find other people!

12:00PM: We are moving into the third section of this conference, and talking about social media. Can reach patients, can reach students. Train students to learn to the story of illness, which is increasingly shared via SoMe. See past the disease and into the person. Getting away from cookie cutter care. Social media can bring individuals together, and power experience. Learn with each other and from each other. Expanding empathy via virtual beds. Good introduction on social media.

12:08PM: Yay! Pharmacy presenting on social media and pharmacy education Stuart Haines, University of Maryland. Social media is a mixed concept. Is any tech that can help communicate together then social media? Son's homework example of what social networks/media he could find, and the son found 64 sites. Shoutout to Mendeley and ResearchGate. Be interested in the educational goals of social media, and not the technology itself. I think thats a good point, sometimes we just get caught up in the tool and not the outcome and can quickly jump on different platforms with no plan. Need to to methodologically select the right tools and introduce in such a way for the desired outcome. Causes some thoughts on instructional design. Want competent caring individuals at the end of all of this after all. Understand the audience, and what is there levels. Conversation (e.g. discussion boards) can be stilted and tough when the tool is hard to use and new and, also forced at times. Millennials are abandoning FB due to the invasion for coopting the original purposes. Cannot co-opt tools for an educational purpose when meant for something else entirely. iFORUMRX need to look into this.... He's now hitting how using Twitter for back-channel means of furthering educational purposes. Substitution (can change things but doesn't necessarily change to much. Use twitter as a way to broadcast announcements vs blackboard), augmentation (new ways of doing things previous not possible. Students can write papers and notes, but can use a blog and wiki- you can monitor their progress and its a public sphere vs closed door papers), modification (using the tech to do things that wouldn't have been easier, example where twitter is used as an on call messaging service [instead of txt/page] and then using Google Voice for response for DI questions to simulate real world experience and get some outcome, Redefinition (Doing things unforeseen, using computers to design drugs and delivery without being previously perceived), SoMe is a tool to an outcome.

12:21PM: AJAY! Love that he's presenting. Love that he is talking about In-Training, and harken back to Ferguson, and their way groups were working together. Good example of how the reach of an article did a large showcase of solidarity. Stories and experiences in the beginning, but new articles coming out that were 'harder' in thought. I have watched this over the years, and I have been greatly pleased what Ajay has grown. I think students doing this activity is amazing, and leads to large amount of potential innovation. Can use social media to charge students to action (coming out of ivory tower) and encourage activism to a certain level. Coping. Interesting that is social media a good coping mechanism for students? A modern day cathartic mechanism. Grassroot community of being in medical education to learn and feel from one another. Ownership between the members and those that help run it. Institutional memory. Virtual space as the new whiteboard of communicating and sharing. He asks, how do we leverage this for collusion and training of future students? Some criticism and support for growth by administration and other groups to help them grown. Institution must have some support (rally around students) and safe space (fear of retribution and risk of aversion is key).

12:33PM: Berci is talking on the need to teach students on the rise of digital and impacting patient care, as fear that students may not be ready. Watson seems to be a popular topic in the past few days for me. He's showing alot of digital health devices and tools. In 2008 he started his own online curriculum. New skills for students, including digital literacy, good communication (online and offline are the same), assessing technologies. A new medical curriculum - Social Media, Mobile Health, Disruptive Innovations and how to be ready for all of this. I love his social media course via webcina. I like the fact that if they finish all the work online can skip the final test. Heh, he made a shark pool by giving points for those that work to finish the assignments he puts online everyday of the week via FB. Huh, he has a chocolate budget to reward his students. Wonder where that comes from in the department? Appealing to my history (grew up outside Hershey, PA). Digital is just an additional part of their life, and that we need to increase our skills as a human and that computing may replace somethings and we may deserve it as it will be needed.

12:45PM: Social Media Panel now. Good first question about how would we validate social media for accreditation bodies. What do students need to know? Issues is HIPAA and privacy and other issues. At the end of the day, will just scare away students, and lose engagement with students that are 10-20 years ahead of the faculty. EM and FOAMEd, love it. Schools are so damn far behind overall. Berci is aggressive in this sphere, but adaptability with other institutions may be difficult. Pharmacy schools are no different and we are struggling as well. Not about something shiny, but something here to stay. Moderator trying to pull this back, what does a student actually need to know. One panelist thinks Twitter Chats are key. Twitter may not be here in 5 years, but knowing how to engage in the realm realistically is something we need to teach. WE could debate books, JC, and other past tools that todays learners have moved on. We need to avoid disconnected educators. Reality is changing but we are clinging it. Stagnation is dangerous. Medical Futures Lab and Rice University -- Creating content is tough by students. I don't think all students can be creators. Sometimes (my view) the best to ask is them to be curators. Book recommendation "no Mans land(?)" we need to catch up to students. Good question on how to students learn. A good educator can help choreograph the students actions and lives, not a sage on the stage. What can we learn from patients on social media - help see patients as people. Social media can help build context for students on patient experiences. Ajay throws in now about pairing e-patients w/ students. Question now is security and etc. that scares educators away. This is gonna make a bunch of nervous deans. Online space can foster interprofessional space for health professions and students. This is a really remarkable conversation and debate going on. Students fear retribution and permission on public space. Ajay bringing in experience with in-Training that students was a safe platform to speak on. Students and patients want a say in the development of curriculum. Converse, do they have a good insight into what they are getting into? Good insight that not all students and patients want to be online, but clinicians need to be ready for those that are. Politics and twitter, are vaccination a part of the conversation? Can you be apolitical on patient issues?

LUNCH! Sandwiches... meh. Some presenters talked about their teaching modalities in Singapore and in Europe. I really like the thought process of using no classes and just team-based work.

2:34PM: Cystic Fibrosis video, it's interesting hearing the thoughts about how social media can bring together people that should never be together, and have a collaborative support group online.

2:36PM: Bring on the E-Patients. Cystic fibrosis patient presenting on her experiences. Hacked the biomedical research system. She can either wait and pray for a miracle, or engage in her own salvation. Collaborated with researchers and industry to raise awareness and treatment possible. She hopes to engage in an N=1 study to see if she can find treatment. Personally, for me this is an interesting development in drug development and the waves are crashing against traditional research modality.

2:41PM: Huh, Penn State Medical School, again, grew up around there, small world. In any event, introducing the idea of medicine is emergent and improvisational. Now I am listening to Jazz.... Piano trio he is discussing. Think this is his leadin on working together. Assessment of interprofessional practice and how each part plays their role. Jumps into the difference in roles shifting in Jazz and how the music changes. Does this change practice as well. What if all three all did the three parts? Song is "Waltz for Debbie." Showing three different versions. This is a good way of introducing interdiscplinary training in medical education. You can't listen if you don't value the other perspective. Need to develop attitude and skills, understanding and listening.

2:50PM: Innovation in interprofessional education with students. Example of social worker and pharmacy students working with physician. Vanderbilt Program in Interprofessional Learning (VPIL) over the course of two-years working together. Rather interesting premise to create interdisciplinary teams. Medicine, nursing, physician, and social work together in one team. Helps understand what each other is thinking. Each one picks up on different things that the other may not see. ECO-MAP. Positive vs Negative thought process. I REALLY REALLY LIKE THE VIDEO SHOWED. I need to show this to my faculty to be honest. Students seemed to enjoy the learning experience. Goals are to cultivate, prepare, improve, integrate, and nurture students. Move beyond shadowing and towards interdisciplinary work. The classroom allows them to come together and talk about their experiences. Week long immersion over the summertime before their professional curriculum courses start. Learn about each others professions, and team work and thoughts.

Here's the Video!

3:07PM: New lesson, set stretch goals! Heh. Looking at treatment and medical interprofessional care across other regions. Looking at Sub-saharan Africa as a region. Be more afraid of people not getting your message than what they think of you. We need to do a better job of learning from others. Its interesting the comparison to an uncompromising environment. I like the shoutout to world pharmacist day and the case studys. FIP - Education Reports on Pharmacy Interprofessional. I like the comparison she's making between elephants from circuses trained to not escape, and African Elephants which are free. The elephants are the pharmacists in the room. HAHA. Namibia are working together to solve health disparities. Sick patients really focus the mind on important things. Tim Rennie. Gave an opportunity for pharmacy students to be collaborative and expand services. (Wont lie, took me awhile to warm up to this presentation, but now I love it). Interprofessional curriculum and Professional Curriculum. Maybe we are thinking the wrong way trying to have them both all the time. They are using mobile for interprofessional learning. I like this, and need to read into this. More.

3:20PM: Panel Time on Interprofessional! Can VIPL have a patient? Yes. Patients come in as mentors for patients. Students are asked to work with patients and follow them through the whole visit to understand the visit and experience and how the system impacts them. What does a successful interprofessional team look like? Patient is part of the team, and understanding each members role. Ultimately has to be a captain and the patient doesn't have to put it all together. The captain can help lead and partner with the patient. Patients expect that teams are much more interprofessional than what the system actually is, just as students think that they would naturally work together and train together. You realize how disjointed things are when something goes wrong in a crisis. Challenges is getting students together from different backgrounds (This is a common question/issue I hear from other institutions looking to implement interprofessional education goals). Everyone's curriculum has a little fat to burn off... But now everyone needs to cut something good out of their program for the chance of something great (interprofessional goals). If we only see roles and not human beings then nothing changes. "Are you internal medicine?" I think alot of good thoughts, having students eat together and spend time together instead of siloed is important. Patients need a bigger say and involvement. Can we just put classes together if overlap? Of course, the registrar may hate it, for a class to have credits for 2 different (or more) professions. Competency is important. Students can do alot, and students can generate alot. I suppose the question is whether the faculty can come together and back it up. We should be excited about the differences in the professions.

Break Time! OOOoooh, Cookies....

4:05PM: Video on E-Patient with Lupus. Sad hearing about being advised to drop out of school. She starts looking into it. Millennials with chronic diseases seem to be leading alot of the work in this area to a certain degree. Chronically ill students need an advocate for the school environment.

4:07PM: Introducing the e-patient on Lupus. Told to leave school. But then what? School is what she knew and what she strived for. Empowered patients know what they want. Empowered patients become experts in their own health. Providers need to know what the patient wants as well. Get to know the patient, and spend time with patients.

4:13PM: Scripps Health. Certified Doctors = Certified Beef. Nice analogy. Ooooh, getting into the debate on the whole issue of certifying testing? Cost is huge. Hard to tailor to individual practitioner. Used to be every 10. Now Maintenance of certification (MOC) every 2 years. Posted a petition to rescind new requirements. He got alot of signatures. I have heard about his a year ago with the drama going on. Its a money making item from some comments and debates. There is alot of data, but not for MOC. He's pointing out some COI in post education. Everyone says we need more data. What ever quality data will we get? We aren't going to randomize. Always going to be registry data. Maybe we don't need alot more data. Some thoughts about making another national board [of physicians and surgeons]. Going the CME route, and not for profit. Board members are not paid. Simple application. ABMS and ABIM are now in conflict. Due to Social media over 2,500 physicians are now certified. NBPAS.org. supports lobbying power for hospitals. Physicians can put the horse back in the barn and take back leadership.

4:25PM: Is CE a cognitive process? Cognitive Dissonance. We need to help learners move from working memory to long-term memory. Adult teaching theory. Maybe everything we done is necessary but not enough. Do learners know how to learn? "How do learners learn" Research project. What actions do learners take to actually learn. 1. What are the actions? 2. How and when are they used? 3. Do they work? Went out and interviewed 300 clinicians. What strikes you that you need to learn (cognitive dissonance). Four primary themes of learning. -- 1. Note Taking (not an event but a process) 2. Reminders (only as important if we refresh and reuse it- You may think you will go back and look at it, but probably not) 3. Search (not all of the information you need is important -- Mindfulness of time -- lets say we were talking about a study, but when we get to inclusion/exclusion you may go on a tangent while being taught, the learning process is fragmented) 4. External Nudges (Due to all of the different strategies the educator plays a large role in nudging the student back to attention "Maybe you want to write this down... The following is important..." need to then related back to each other. The how and when came up next. Habit and convenience versus Trial and error. No trial and error in the way we learn. Do the actions that learner take (largely as a action of habit and convenience) ultimately help them. Best case is yes it works, but if not we are in trouble. How do you interact with content actively as you 'learn' it? We need to question the environment of learning. Take away: We are relying on these learning actions. Can help us work smarter and not harder. We need to acknowledge that each action may act an accelerant to learning or a barrier. We are the architect on the learning experience. Less PP and more on presentation to learn.

4:38PM: Panel Time on lifelong learning! CME and experiential learning. Sorry, notes on this section will be static as I got distracted by another issue (don't you hate that?!). Feedback is important. Finding data is key. Patients/advocates helping to teaching practitioners on habits? To practice is to learn argues one panelist. Another panelist points out we never learn how we learn. Not a learning style conversation, but competence issue. Effectiveness of learning is different than efficiently of learning. Patient advocates as risk management, or a safety net. Trying to find a good solution for learning. Opps, patient advocate graffe? Think theres going to be some conversation on this. How can we make life long learning a reality? Patients and doctors getting to learn from each other, but someone gives and someone has something to give. Build a culture where the clinical sphere is not just a job. As clinicians we need to see our sphere as not as where we do our job well but where we learn as well. What one thing am I working on today? Classrooms are poor ways to learn, but the hallways are good. Multiple choice is out of date. Need more patient based.

5:16PM: Wrap up time, Dr. Chu coming up to speak. O look, a survey coming to us! Want feedback. Wonder if anyone mines this for scholorship. No chocolates, whoever completes both days will get a free registration for MedXEd next year. I will see what workshops I have tomorrow. Bringing up to stage everyone who played a large role. Nice to see the effort that goes into this.

5:22PM: Abrahm Verghese is going to speak now for the closing keynote. Vice chair on the theory of practice of medicine. Beginning talk on the issue of the educator of Helen Keller and her rough upbringing. Annie Sullivan training of Helen Keller. Breakthrough came with w-a-t-e-r moment. I think we all strive to achieve this in our students. That awe in their eyes as it just... clicks. Our greatest moments of epiphany are sometimes just with ourselves though. Now jumping to William Osler - he has shaped so much in american medicine. One of the founding physicians at John's Hopkins. Osler wrote alot about medicine and teaching. The physical exam (auscultation, percussion, etc) followed by reflection (get this picture of Osler) and then there is that famous picture "the doctor.' Social importance images were important at this time, and the doctor of that time was one of reflection. The artist child had actually died on Christmas Eve and was the motivation. Slogan "Don't let the government take the doctor out." Speaker does not agree with interpretation of doctors. The picture is us projecting ourselves into the child at the center of attention. "Bible" reference you clothed me and fed me "I was ill and you fed me...." Matthew. Fear if this image was redone, it would be on the computer. What is the doctor of this day. Rounding with patients and table rounds. Schwartz rounds. Conference room rounds and we face our computers. Its not the doctors fault, its our fault as educators. This is impacting physicians (and healthcare at large) with burnout. More time with a computer than with a patient. 4000 clicks over a shift. Physicians are spending more time logged in and online on the computer. Hard to discern with new data, when the doctor actually sees the patient. Mobile is ubiquitous in our communication. Sometimes the answer is right in front of us, but we dont grab it and failing to read the patient. We are failing to perform a physical examination and causing errors. Upcoming publication "Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes" since no one examined the patient. Losing a ritual of medicine -- being with a patient --- ritual helps us with crossing of a threshold and helps as a binding action. We shortchange our patients when we dont do the ritual well. Do not cement the bond. What is the pharmacist ritual I wonder, did we lose it with compounding. Good image with apprentice in Indonesian sword maker. Interesting the art is dying. Are notes fiction? Should not be in the medical record. Stanford 25 website. Medicine is a very human experience. Nurturing function of medicine. Need to be there for our students. "dont dig because there is no gold there" on the exploration of the spleen - Let the spleen palpate your fingers and not the other way around. Galen, Hippacrates, Osler, all are models.

Hope you found this helpful! I will most likely sit and reflect and write a wrap-up in a week after finishing tomorrows workshops.

Why the Pharmacy Needs Changing

So let's jump into it. The modern pharmacy is a enigma of technological developments. We have finally reached the point where we can process prescriptions sent electronically, but still rely on a fax machine (it's fascinating that the pharmacists graduating today are having to learn about a piece of technology their parents used, but they have never seen before), where the pharmacy is cut off from the major technological developments occurring int he health sector, such as integrated EHR platforms, digital health solutions, and telemedicine.

Pharmacy Practice has changed significantly in the past, we stopped compounding 90% of the medications we had to in the past in favor of mass-produced pharmaceuticals, we are earning provider status nationally, and are expanding our capabilities. The modern pharmacy does not demonstrate many of the clinical abilities of the modern pharmacist. That being the case, I have to question if the modern pharmacy is capable of keeping up with the times?

Envisioning a Future Pharmacy Environment

I wanted to take into consideration some major changes the health field and pharmacy practice are going through when I thought of how the pharmacy store could be updated. This included the following, and were the starting points for my imagination.

Improving Pharmacy Dispensing Process and Inventory Management - So there are a few things here I think that can be improved. Namely the whole process of receiving a prescription, filling it, and verifying it by the pharmacist. Obviously, this is not all the considerations that need to be taken into account. Often, patients and other health practitioners forget that the pharmacy is more than a place to 'count, lick, stick, and pour,' but is a veritable operation in itself from drug acquisition, management of inventory (no one wants to get expired medications), billing for prescriptions, and data management. Pharmacy has alot of laws, and they vary from state to state. That being the case, some areas may be addressed from some recent advancements. For instance, filling of medications off-site has shown some success, and I would say Wegman's has done a good job of filling their medications at outside facilities and then delivering to the pharmacy for patient pickup, which really reduces the workload of the pharmacy staff to concentrate on immediate fills. Other advances I have seen includes the success we are seeing from PillPack who have brought an 'oldy by goody' pharmacy automation technology to the mass market by using multi-drug dispensing systems for mail order. Automation is a big solution, and I think it is slowly getting better. However, application of it always seems to be a barrier. Sometimes, I think pharmacy could learn alot from other industries that have to deal with mass inventory management, and I would say Amazon has always impressed me. I think that pharmacy needs to turn an eye to others for possible new disruptive technologies to change up the way it delivers medications to its patients.

Expanding Pharmacists Roles and Duties - Sometimes I think the modern pharmacist is the most overeducated individual for their position. We have been fighting for years to expand our clinical skills and services to patients and be reimbursed for such services. Provider status is slowly coming to the profession and I think that it will take time, but we will eventually get there. That being the case, the space to function is drastically compacted in the pharmacy to engage in such roles. Look at vaccinations, we are doing it in the aisles behind a screen. I would fully support the development of suitable space for pharmacists to engage their patients. This space would be a better environment to provide patient counseling, point-of-care testing, various other services. I feel that if pharmacists want to be seen as providers, the environment should suit such roles.

Patient Engagement and Expanded Services - I look at the 15 or more minutes the patient waits at the pharmacy as wasted time for patient care and engagement. Yes they can shop, and I think that should be encouraged for business purposes, but often times a patient playing on their smartphone could be engaged better. I propose a redevelopment of the 'waiting room' for patients. One where we give them something to do that could impact their personal health. Lastly, I think there are alot of opportunities to leverage the role digital health has been playing in our patient lives by directly supplying and using such devices in the pharmacy.

Envisioning the Digital Pharmacy

The following is a mass amount of different thoughts on how the pharmacy could integrate things I have seen or thoughts on potential developments. That being the case, some of it is farfetched, but in an age where we are experimenting driverless cars I figure why not think of the possibilities. Maybe someone would make it.

Augmented Reality Pharmacy - I like the idea of Google Glass and Microsoft's Hololens and Facebook's Oculus Rift. I think the concept of augmenting how we perceive the world is interesting, and I can see some applications in the pharmacy, after the initial quirks are worked out. For instance, I think it would be interesting on the production side of things to be able to see when I start to fill the prescription, the information is presented in front of me, along with a beacon or alert of some sort telling me where the drug is in stock (along with how much and if there is not enough), a picture of what the drug should look like, and where the patients medication is when ready for pickup. There are some possibilities here, and I heard others envision facial recognition as a tool to identify patients instead of just asking for their Name/DOB/Address as a means of ensuring the right medication for the right patient. Other applications will be interesting I think for pharmacists, whether it could be teleconference with other specialists (e.g. dermatology) or even helping to show how to do a compounding procedure they never done before, or just even IT support.

Wearable or Associated Technological Support - Bouncing off the previous idea of AR, I think the sheer amount of digital tools available could be better leveraged for pharmacist and staff support. I know many pharmacists that use their smartphones to look up drug information or access other literature when answering patient questions (often because they can't access the web browser on their own workstation, yeah). Apples recent live event showed how the Apple Watch has a HIPAA compliant app coming out that shows patient's data (e.g. lab values, EKG) in real time, and allows them to communicate with others. I mean, I think thats a great thing that we are leveraging these mobile tools as potential solutions to daily workflow, and I see no difference for pharmacists. Some wearables could be used to update the staff on alerts or questions or other items that come up.

Patient Use of Mobile - Here I think we can make huge inroads. I recently read a paper asking how iPads could be used in the hospital while a patient is being monitored, and it explored the possibility of using it a teaching tool. I see no difference with those that wait in pharmacy. I think if patients used their own devices, or one supplied by the pharmacy, they could be engaged in their care. First, this could include having the patient update their personal information, and insurance (e.g. image capture with the camera), along with say forms that need to be filled (e.g. vaccination). This data could be then transmitted to the pharmacy database, instead of having a tech enter it in manually later on. Other considerations include giving the patient digital prints of their drug information (instead of physical copies that get lost/thrown away), along with videos or articles around their disease states and treatment to encourage any counseling points, patient questions, and adherence. To help reaffirm such methods, quizzes or assessments could be given via the device that the patient can partake in, and be awarded (e.g. pharmacy points, coupons, discounts).

Patient use of Digital Health Tools - So here is a big changeup for me. I think pharmacies should be selling digital health tools (e.g. fitness trackers, associated health wearables), and show patients how to use them. I think the doctor office is limited, and Best Buy and the Apple Store are limited options with a lack of health advice associated with it. I would say set something up similar in the pharmacy to what Apple or the others do, so that when the day insurance companies start reimbursing these things we are ready. In addition, I would say have devices loaded up with health apps for patients to play with that are sponsored by the pharmacy to learn about and potentially use in their own care. Along with this, is that wearables and apps offer a good opportunity to collect data for chronic diseases that pharmacists can leverage in the treatment of patients and use for pharmacist provided service (see below). I mean we sell glucose and blood pressure monitors afterall and teach patients on them.

Pharmacy Clinical Activities - As a mentioned, a space should be set apart for a pharmacist to perform clinical activities, such as vaccination, POC, counseling, etc. I think that if patients are approached (such as above through mobile) we could even have patients schedule time to meet a pharmacist for services, such as Medication Therapy Management. I think this is all piggybacking off of current pharmacy functions, but expanding time and effort along with possible reimbursement. Other items I think include using data collected from pharmacists using digital health tools. What are you eating? Hey, here are some options for a healthy diet and store coupons. Hows your blood pressure? Let's call and go over current therapy, adherence issues, and if necessary adjust therapy with a collaborative agreement or let your doctor know. Testing? There's Theranos to handle it, and we can get some lab values for that. Got Digoxin? When was your last levels? Here we go. I se alot that can be accomplished and that pharmacists can do with all the recent advancements going on.

Where do we go from here?

Nowhere, anywhere, it's hard to say. I think the biggest limitation to updating the pharmacy environment will be pharmacists and corporate. One, pharmacists don't like change, and our training is all over the place. Sometimes I worry about a pharmacy schism of sort happening between clinical pharmacists and the majority of the profession. Let me be clear, I see the changes coming to all pharmacists, and not a select group. I think with the training we have we can do the above and be fine. Hell, I think most pharmacists want to expand their services and have more patient face time and offer clinical services.

Nonetheless, the other component that will limit is cost and corporate. Do they see value in this and a financial benefit? Maybe in time, CVS and Walgreens are on my radar due to their pursuit of minute clinics and on-site testing. They are embracing digital. I think they recognize with changes in insurance for the country, they have a market they can grab. Whether they see including pharmacists and staff as part of it will be the conundrum.

As always, feel free to leave comments and recommendations! Also, feel free to download a PDF of my infographic.

the space of an academic pharmacist with geeky tendencies

I am not a man with much bravado in my thoughts to say the least. So while this website was created as a virtual curriculum vitae and portfolio, I have also decided to write on a few topics, including technology in pharmacy, my musings, and how to be more productive in daily activities and at work. Please feel free to explore and see my portfolio, or stick around and see what I have to write about.